120 
The Minute Anatomy of Two Cases of Cancer. 
embryo as affording many examples of epithelial formations, which 
proceed originally from the epithelium of the surface, but become 
disconnected with it at a later period of their growth. Thiersch 
did not fail to observe the fact of the frequent anastomoses of the 
cell cylinders, which he has very well figured in fig. 1, Taf. IX, 
but this circumstance did not shake his confidence in the view he 
had propounded. 
Billroth maintains similar views to those of Thiersch, not 
merely for cancer of the skin, but also for mammary cancers, and 
in fact for cancer generally.* In the last edition of his lectures he 
mentions the view of Koester as “ enticing,” but thinks that “ all 
his evidence in favour of this view is not tenable.” f 
I would call attention, however, to the fact that the manner in 
which the cell cylinders anastomose in at least many mammary 
cancers, points rather to the lymphatics than to the mammary- 
gland tissue. Moreover, when a mammary cancer returns after 
extirpation, or when secondary growths develop in distant organs, 
as in the case reported in this paper, the new formations are 
generally constructed upon the same structural plan as the original 
growth. To reconcile these facts with Billroth’s views, we must 
resort to far more complicated and improbable hypotheses than 
those of Koester. 
Billroth was well acquainted with the anastomosing cell cylin- 
ders in certain forms of mammary cancer. He describes such 
growths as the “ tubular form.” According to him, mammary 
cancer in general almost always begins “ with a coincident enlarge- 
ment of the small, round, epithelial cells in the acini, and with small 
celled infiltration of the connective tissue around them.” He admits 
that it is “ difficult to make out the further fate of the glandular 
acini,” yet he has no doubt that in the tubular form “ the acini do 
not maintain their form, but grow into the connective tissue as very 
thin cell cylinders, while it becomes infiltrated with cells.” I men- 
tion with interest that fig. 144, page 643 of his work (toe. cit.), 
agrees precisely, so far as a woodcut can represent the micro- 
scopical appearances of a morbid growth, with portions of some of 
the sections of the two cancerous breasts described in this paper. 
In it, as in them, certain figures which undoubtedly represent 
more or less modified gland acini and ducts, lie side by side with 
the cell cylinders, which are variously shaped in accordance with 
their relation to the plane of the section. Both are imbedded in 
the same connective-tissue stroma, but in his figure, as in the 
Museum preparations, no anatomical connection between the two is 
shown. They are separated always by connective tissue. 
* ‘General Surgical Pathology and Therapeutics.’ By Theodore Billroth. 
Translated by Charles E. Hackley, M.D. New York, 1871. 
t Loc. cit., p. 631. 
